In other words, this section of H.R. 3200 would require Medicare to pay doctors when they counsel their patients about such things as living wills, but no more frequently than once every five years, unless there’s a significant change in health status.

These people don't understand basic economics.

If doctors can get paid for it, they'll do more of it.

And how is the government going to know whether or not the patient initiated the discussion?

The doctor will just mark on her Medicare bill sheet that she gave the counsel, and the government will pay her, and the patient will never know that he “elected” to receive it.

End result: more end of life counseling given in a treatment environment that will indisputably be penurious, if Obama gets his way.

It doesn't push suicide, it just pushes the elderly to refuse "active treatments" in favor of hospice care. That is, no more investigation or therapy for new symptoms, cancer, or disease, just drugs to manage discomfort and pain.

For example, no dialysis after age 70, like in Canada and the UK. Renal failure is a good painless way to die, and quick. Plus it will save us a lot of dough.

No bypasses, hip replacements, or chemo for you, either, granny. But you can have all these yummy narcotics.

Not suicide, no; not even euthanasia. Those options will seem more attractive, however, to end the inevitable suffering.

I agree with you, at one level: the bill only encourages (?mandates?) periodic review about end of life care (Do you want full CPR? Food and water only? etc. etc.) This is not all bad, and I think many conservative sites opposed to the bill have gone way too far in concluding that it is a Trojan horse for euthanasia. Silly -- and it demeans the value of many of their other arguments against this horrendous piece of legislative crapola.

However, clearly the focus is on "wasted" resources (aka money) at the end of life, and the administration and Congress are listening to utilitarian bioethicists such as Ezekiel Emmanuel (brother of Rahm), whose philosophy about health resource allocation I find very chilling -- sacrifice the individual for the good of society, essentially. Scary stuff, which should be read by anyone interested in how these folks think. It comes dangerously close to eugenics, IMO.

When you combine this utilitarian philosophy with the burgeoning physician-assisted suicide movement (now legal in 3 states, soon in many more), you may well have something of a perfect storm. Oregon is already telling cancer patients it will not pay for palliative chemotherapy, but will cover PAS.

1) FactCheck is not a neutral 3rd party in this discussion. Just looking at the "FactCheck" which follows this one on "Boehner's Baseless Claim." Even they're forced to admit that his claim isn't "baseless" at all despite their own headline. They spend paragraph after paragraph adding "nuance" to the subject and even have to add "Obama's Response." All for a topic on which Boehner's claim is factually accurate. Neutral? Not in the least.

2) Maybe if Obama wasn't trying to jam this bill through at Warp 9 then people would have time to figure out what actually is and isn't, but when you have to try to decipher 1000 pages overnight because Democrats are threatening to hold votes on it every day, mistakes are bound to be made.

I can easily see how someone would read the definition page without understanding the greater context of that definition given that Democrats are purposely not giving people time to sit down and obtain that greater context because their poll support is melting down at exponentially faster rates every day.

Agree with Pogo--narcotics are much cheaper than life prolonging interventions esp when you reach your life expectancy--simply hand out morphine and withold surgeries. these old coots are going to die anyway.

Seems to me as Jim and Dr. Bob have pointed out, the "rahm it through approach" is leading to precisely these kind of bogus stories. On the bright side for opponents of this terrible legislation, this is fine by me, because it makes the administration have to try to explain what they want. And Obamas' numbers keep declining personally and on the health care issue overall.

Voting on this piece of garbage is now apparently deferred until October. For all the leaked bogus stories about "progress in the house," there isnt any. The honorable members will go home for the August recess and get hammered at home--Which, of course, is why the administration was hoping for a July bill.

At this point, Obama might want to go back and look at Hillary's attempt in 1993--the longer it took, the more it fizzled.

And I note that in the midst of the worst economic downturn since the great depression, Mr. Obama has sprung for a 20 million vacation get away on Martha's Vinyard. hmmmmmm

I made a half hearted effort to read the relevant passage. Perhaps lawyers read it differently, but I found the prose to be obfuscatory and confusing. There seems to be room to hide just about anything behind those hedging clauses. And there are 1000 more pages of this. It's not that no one has read it, but that no one can read it.

However, clearly the focus is on "wasted" resources (aka money) at the end of life

Right. I don’t care about counseling, I care about denied treatment! That may not be euthanasia, but the results are going to be the same for some patients. You either get a potentially life saving treatment, or you die. That is not a decision I want anybody making but family.

But they don't have a dog in this fight. Nope. Not at all. Nothing to see here. Move along.

Annenberg never ever ever would be caught engaging in spin as they are here and have been found to do elsewhere as well. Even thinking that they would be as crazy as throwing millions of dollars at a domestic terrorist fronted by some uncredentialed, inexperienced nobody named Barack Obama. I mean who would believe something so utterly ridiculous?

I mean, it's not as if there has been a big physician-assisted suicide movement and euthanasia movement the last several years. And it's not as if many people have been killed by assisted "suicide" and euthanasia, including by starvation and dehydration.

It's not as if people have been pushing utilitarian and eugenic medicine for over a hundred years.

Reality check time. In professions the ethics are pointed to do the best for the client/patient who is the customer who pays the money for THAT PURPOSE. When the hiring customer is the Government, then a whole different set of purposes are a target aimed at and hit. As individuals we hire someone for our good. As a government, we get Jeremy Bentham's point of view that always calls for less for us and more for the "Greatest Good for the Greatest Number". Humanism turns out to be fierce and heartless destroying force to the one person, who is you and me. As an example, I changed insurance plans one time and had to pick a primary care doctor from a new primary care panel. In the bios of the doctors was a new Harvard Med school, black woman doctor, and I tried her. She was a trip. She was very efficiency oriented and never really saw me, but had a statistical approach to public health in which my vitals were not me but were my statistical grouping under age, sex, and race. All she wanted was fodder for her mill. I had to be treated for what I should be at risk for whether it was real or not. It was like Robert McNamara's way of running a war in Viet Nam. Hitting all the wrong targets out of an arrogance that they knew stuff that no one else did. If you want a real doctor who respects reality treating you, and not a statistician guessing at your needs, then steer clear of Harvard educated people. Ergo, steer clear of Obama's new world of health care where you will become the last important player in a scheme that is really all about money and power elites. That is my answer to whether Obama's plan is morbid...yes it definitely is for you and me.

Look I'm just not buying the idea that this plan will decrease quality. The only thing that really matters is the public option which would be a brand new entitlement program with a new tax hike to fund it. Even liberals agree on that.

Here's an idea, those that support these kind of "end of life" finacial balancing acts should go ahead and sign up now. Why wait until you are 70, Rahm and Barack? Chances are that at 48, if you have a serious life threaterning health issue, there be several more and that will add up to some big bucks.

Just do the country a favor and refuse treatment or better yet just don't even go to the doctor. Patriotism and concern for others begins at home.

Page 425 does deal with counseling sessions for seniors, but it is far from recommending a "Logan’s Run" approach to Medicare spending.

In fact, it requires Medicare to cover counseling sessions for seniors who want to consider their end-of-life choices – including whether they want to refuse or, conversely, require certain types of care.

AJ Lynch said..."Jeremy, by approving payment for a service, the govt in effect is endorsing & promoting it."

You mean things like testing for AIDS?

Inoculations for the flu?

Regular check-ups?

Deciding how and when one want to die is certainly none of the government's business, but it doesn't hurt to provide specific counseling so all the facts are at hand. My father spent the last 6 months of his life in constant pain because he was in a Catholic hospital that did not believe in pain medications (didn't want him "hooked" on drugs) or hospice (because it was considered a form of "giving up.")

It's pretty much changed at this point, but before their was open counseling it was purely up to the doctors and staff and whatever their religion- based policies were.

I just don't understand what the gripe is here, other that the usual whining and bitching about everything and anything.

Do you remember the famous Doctor Zhivago's line, "I have always worked." when the marxist thugs ruling over his life tried to find reasons to kill him, and anyone else they could, for any reason, but really because he was a better man than them. The good Doctors who will to serve patients instead of serving the State will be the biggest losers in the Obamination.

Pogo said..."End-of-life counseling is the very mechanism by which the government plans to withhold care."

I've read absolutely nothing that relates to any plan to "withhold care."

When a doctor "counsels" a patient, and has to tell them that they have little chance of survival, it's the patient's choice as to what course the doctor should take. No doctor is going to "withhold care," based on what he or she feels is appropriate, without the patient's consent.

This was a Catholic hospital, and number of years ago, before many of these same hospitals began to loosen up.

They felt pain medication over and above the basic low level meds were overboard and would lead to "addiction." My father was already "addicted" to death, the doctors told him he had less than a year, and in fact died within months...so whatever pain meds would have only alleviated his pain and suffering. (Today it's common for patients to get morphine, etc.)

As to the hospice program, many of the more religious hospital didn't buy into providing counseling and comfort as the death was a given. They felt it was a form of "giving up" before God made that decision for them. (Today hospice is common, with many patients allowed to pass on in their own homes, surrounded by family and friends.)

Right now, one of the problems we have is over-testing, continued treatment when it's obvious survival is not possible, and not allowing patients to control their own destiny, as is their right.

Living wills are the best means of controlling one's destiny, and most people don't even have those. Had Terri Shivo had a living will she would have saved everybody a ton of grief.

Jeremy...Good doctors who will to serve the patient will be enslaved to the State aparatchiks who set all rules and set compensation as low as it can get. The good doctors will go elsewhere and you and me will not have a free country to go for quality care unless we are wealthy enough to pay for our care in Thailand by Israeli doctors

This is a paraphrase of liberal DEM Congressman Joe Sestak on the 1,000+ page healthcare bill which he supports:

1-The fewer govt regulations, the better the health care system.2- Doctors should be paid based on the health of their patients. We should review the health of 100,000patients or so to determine if the doctor gets paid a lot or not so much.

1. Ha ha ha!! Yes indeedy, they will; see HMO capitation from the 1990s for the template.

2. But the care is withheld most often well before the patient gets in the door, by restricting available specialists, technology, and treatments. Delays, long queues, and cumbersome protocols serve to deny care as well.

Medicare and Medicaid are both single-payer systems and you'll find very few who do not like what they get.

*When asked in a new Harris Poll 76% said they strongly support the treatment they receive through Medicare and 71% supported Medicaid.

The Veteran's Administration also is a single-payer system and other than a few of the recent hospital condition scandals, the treatment and service has been in place for a long, long time, treated millions of American vets, and given high marks.

*In 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality , in all 11 measures, the quality of care in veterans facilities proved to be "significantly better."

Once we actually have a national health care system, Americans will wonder what took so long...and why we paid so much for so little...for so many years.

"Medicare and Medicaid are both single-payer systems and you'll find very few who do not like what they get."

A couple problems there. First, a big part of the emphasis for health care reform is a result of the reality that Medicare is fast going bust.

Secondly, that is even without taking into consideration that more and more of the Medicare, Medicaid, etc. care is massively cross-subsidized by everyone else getting health care - primarily by those evil insurance companies. How is this done? By setting reimbursement levels below cost. And every time you hear about all the money that Medicare, etc. are saving by cutting costs, remember what they are doing is cutting reimbursement levels, which are already mostly below cost. That means that they aren't saving money, just forcing the public to subsidize them more.

One big problem with trying to expand these programs nationwide, or, indeed, impose either single payer, or public option, is that the only way that these programs work right now is due to the fact that there are a lot more people outside the programs cross-subsidizing them, than there are in the programs.

So, just imagine what would happen with a single payer system that tried this trick of driving down reimbursement rates in the face of rising costs. Many, if not most, doctors are already running extremely highly leverage operations. This would tilt them almost immediately into the loss territory, and if there isn't anyone left from which to recoup, then they are just going to quit.

"Investigators say the surgical unit at a southern Illinois veterans' hospital was in such disarray that doctors were allowed to perform operations they weren't qualified to perform and that hospital administrators were too slow to respond once problems surfaced, leading directly to the deaths of at least nine surgical patients and as many as 19.

Two internal Department of Veterans Affairs investigations also found that the medical mistakes seriously harmed more than a dozen additional veterans who were patients at the Marion, Ill., VA Medical Center."

"This is a summary of events that occurred in a V.A. Facility in Philadelphia Pennsylvania 2002-2008:

When the Veterans hospital started their brachytherapy* program in 2002 it provided vets with an additional, less invasive therapy for prostate cancer that had not yet spread to other areas of the body. The new service was staffed via contract with staff and professional radiation oncologists from the University of Pennsylvania. The particular physician in question was trained at both Johns Hopkins and Penn.Between 2002 and 2008 the implantation error ratio was 96:116 procedures.

Patients believed they were receiving the correct dosage needed to treat the cancer, however their prostates were undertreated and other organs were exposed to radiation they not only didn’t require but were damaged significantly."

"FORT HARRISON, Mont. - A doctor at Fort Harrison's VA Medical Center who is accused of improperly conducting patient exams and altering records to reflect care that was never given was fired based on the findings of an investigation that began last year.

The hospital declined to release the name or specialty of the doctor, who was fired March 13. But a spokeswoman for the center said his patients were told of the findings and were assigned to another practitioner."

"Medicare and Medicaid are both single-payer systems and you'll find very few who do not like what they get."

I thought Barry promised his health care plan was going to lower costs. Medicare and Medicaid are about broke and have only resulted in higher costs.

"The Veteran's Administration also is a single-payer system and other than a few of the recent hospital condition scandals, the treatment and service has been in place for a long, long time, treated millions of American vets, and given high marks."

Been there, done that, it ain't all that you believe it is. And it is on a much smaller scale and dealing mostly with specific veteran's health care issues. Neither it nor the military health care system can be easily transferred to a total system for all Americans.

"Once we actually have a national health care system, Americans will wonder what took so long...and why we paid so much for so little...for so many years."

Also, decisions are made everyday in single payer, government run health care systems to deny treatment based on cost-effectiveness. For example, limiting an expensive drug treatment for breast cancer was a major issue in the last New Zealand election.

But we digress. Let's see, what was that pesky question you keep ducking?

Wasn't it: Do you really contend that the Obama/Dem bills will not result in limitations to health care for the elderly that will bring about earlier deaths?

elHombre - Terri Shivo represents the perfect example of someone who has literally no control over her own destiny, being taken advantage of by others.

She was brain dead, it's been proven beyond a shadow of doubt through doctor's reports and the autopsy, yet people like yourself still think the poor woman should have remained alive so the nutcases on the Christian right could use her as some kind of standard bearer.

You are both wrong. VA does a lot of things well (and has missteps like any other hospital), but people going to the VA have an option to go somewhere else if they aren’t happy. That is what we need to preserve.

They felt pain medication over and above the basic low level meds were overboard and would lead to "addiction." My father was already "addicted" to death, the doctors told him he had less than a year, and in fact died within months...so whatever pain meds would have only alleviated his pain and suffering. (Today it's common for patients to get morphine, etc.)

So instead of it being the Catholic Hospital, it will now be Sally Satchelbottom the government clerk who witholds treatment.

After all it was Obama who said that people will have to give up treatment that doesn't make them well. Since your father was going to die anyway, why waste money and time on him with pain killers that really aren't going to make him well. Same thing for those with AIDS, Parkenson, Diabetes and other illness from which you will never get 'well'.

What do we want to keep your father alive for anyway? He is old, using up resources and the sooner he goes the better for the State.Brave new world. Welcome to it.

H.R. 3200, page 425: Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning...

What FactCheck left out was that the "practitioner described in paragraph(2)" of the bill has to be an employee of ACORN.

Shanna, some VA hospitals are in fact pretty poor, and although 'shit-holes' may be excessive, they're no reason to celebrate.

VA hospitals are variable, like all other hospitals. Plenty of regular hospitals are poor too, it just doesn’t make the front page of the NY times every time anything happens. Lord knows I’m not trying to hold it up as an excuse for Obama Care because I really don’t want that. But, they are often unfairly maligned. I imagine some of your older patients remember the old days when things were very bad indeed, but they have improved quite a lot since then.

One thing with the VA is that they are dependent on congressional funds, and so they go though fat and lean times, wholly dependent on what is politically popular at any given moment. It would be a really bad idea to make that true of the entire government’s health care.

And as I mentioned, you can choose to go or not to go. That should be preserved.

Dust Bunny Queen said..."So instead of it being the Catholic Hospital, it will now be Sally Satchelbottom the government clerk who witholds treatment."

As usual, you're on the wrong page.

Things have changed dramatically as far as pain medications and hospice are concerned.

I described my father's situation, and as I mentioned, it was a number of years ago.

I suggest, when your time comes, instead of relying on the medical staff you refer to as "Sally Satchelbottom the government clerk who witholds treatment" (which makes absolutely NO sense whatsoever - other than being the standard wing nut insanity), you stay right there in your little trailer and let whatever God you believe in handle matters.

1. My mom was a veteran of WWII. In order to get her FREE! healthcare from the VA, she had to travel two and a half hours to the nearest VA hospital. Never saw the same doctor twice. When it became difficult for her to travel, she still had to make the trip because the VA wouldn't refill her meds without seeing her.

2. Husband of a friend had a seizure in Paris. Ambulance took him to the finest hospital in Paris (largest in the world, I'm told). An MRI would help them figure out the cause of his seizure; the soonest he could get the MRI was in a month. He flew home to the US and had the MRI the next day.

Jeremy: "Yes, most doctors go into the profession to maximize their incomes."

Yes, Jeremy. Yes, they do.

Because becoming a Doctor is HARD. You know, like pull Barbie's string and she says, "Math is Hard." Really and truly HARD. Not only do you have to be really smart, but you have to spend the better part of your 20's busting your butt instead of having fun or having babies. The school just never ends.

So anyone who is SANE, Jeremy, who contemplates becoming a Doctor is going to be looking at what they will get out of it.

Because if they just want to feel good about themselves... they can volunteer at the local soup kitchen and get the exact same good feelings about helping their fellow human beings as if they spend a decade in an excessively difficult school first.

"I imagine some of your older patients remember the old days when things were very bad indeed, but they have improved quite a lot since then."

Actually, these guys have had recent bad experiences in Iowa, MN and WI VAs, and so will only go there for the free meds.

And your point needs to be put in bold, because it is so very very true:

"One thing with the VA is that they are dependent on congressional funds, and so they go though fat and lean times, wholly dependent on what is politically popular at any given moment. It would be a really bad idea to make that true of the entire government’s health care."

The 'fat and lean' times mean wide variations in quality, of course, responding only when there are scandals, such as the Walter Reed debacle last year:'WRAMC's Building 18 is described in the article as rat- and cockroach-infested, with stained carpets, cheap mattresses, and black mold, with no heat and water reported by some soldiers at the facility.'

"His own VA hospital in Livermore was a mess. The gown he wore was torn. The wheelchairs were old and broken.

"It is just not Walter Reed," Oliva slowly tapped out on his keyboard at 4:23 in the afternoon on Friday. "The VA hospitals are not good either except for the staff who work so hard. It brings tears to my eyes when I see my brothers and sisters having to deal with these conditions. I am 70 years old..."

Look, I am not trying to bash them, but when people try to uphold VA hospitals as an example of the goal of national health care, it gives me the shivers, and their skeletons need to be shown.

Most military hospitals are very good. (They also don't have to deal with the same patient demographic... to even get into the military you have to be healthy. Some dependents need care for various genetic conditions or diseases but for the most part military hospitals are dealing with healthy young men and women having babies. That and trauma and injuries, of course.)

The issue with Walter Reed, I'm convinced, was that it cared for soldiers separated from their units and then sent them on. People who need care are not able to deal with any more than their day to day crisis's, rehabilitation and even just staying alive. Civilian family members simply can't navigate the military system and even if they could, they are likely unable to deal with their loved one's condition, much less anything additional to that. Which is why being separated from your unit is such a big deal. Your whole support network might still be in Iraq or Afghanistan or else back home but in some other part of the country. The people whose job it is to watch out for their troops are not there. Your whole chain of command is elsewhere. You're a bit of an orphan.

So then you get well enough to do something about conditions but that means you're well enough to *leave* too. When the Walter Reed scandal hit the news there were people posting to Blackfive.net that they'd been there and were feeling guilty that after they left they didn't follow through to make sure that the soldiers who arrived after them didn't face the same conditions. But the thing is... they weren't *there* anymore and they were still dealing with their own recovery.

In a local military hospital the members of your unit will stop by to see you and even if you don't have energy for more than your own recovery, they *do*. You aren't an orphan. And when you are better, you're still *there*.

That said... like all things military, you can really get screwed over by the system and heaven help you if you have some sort of non-standard situation that must be resolved.

Also, in the end... you CAN go to a civilian hospital and civilian doctors.

When my husband had his herniated disks (three of them) and could get no MRI or exam or anything but muscle relaxants and pain meds, we knew several Airmen that were trying to decide if they could afford to go outside of the (free) military hospital system to get an MRI they could bring back to their military doctor.

We don't know if he'd have gotten better care at our next base because during our leave enroute we were technically far enough from any military hospital that the Air Force would pay for a visit to a civilian doctor, so we had the MRI in hand when we arrived at our next base... they had my husband in surgery with their neurosurgeon before he even in-processed. He was in the hospital for 14 days... and yet, his previous doctor wouldn't even order an MRI.

Yes... the idea of government "fixing" our health care system frightens me.

Yes, how dare anyone question a massive, vague, government takeover. Forget that Obama can't even give a coherent, convincing argument for it in his own press conference!

Those of you who make fun of people questioning this really come across as lapdogs. A lot of democrats are even backing away from this now, and quickly. More and more Americans are against it every day.

Are all these people ignorant? Reactionary? Paranoid? Greedy?

People have real, legitimate concerns. I should say, adults have real concerns. Fanboys just want Obama's plans to go through.

"The assault against seniors began with the stimulus package in February. Slipped into the bill was substantial funding for comparative effectiveness research, which is generally code for limiting care based on the patient’s age.

The harshest misconception underlying the legislation is that living longer burdens society. Medicare data prove this is untrue. A patient who dies at 67 spends three times as much on health care at the end of life as a patient who lives to 90, according to Dr. Herbert Pardes, CEO of New York Presbyterian Medical Center.

Nevertheless, Medicare is running out of money. The problem is the number of seniors compared with the smaller number of workers supporting the system with payroll taxes. To remedy the problem, the Congressional Budget Office has suggested inching up the eligibility age one month per year until it reaches age 70 in 2043, or asking wealthy seniors to pay more.

These are reasonable solutions—reducing access to treatments and counseling seniors about cutting life short are not. Medicare has made living to a ripe old age a good value. ObamaCare will undo that."

God knows you wouldn't want to "denigrate" insurance companies. I mean, hey...just look at how wonder they are and how fair they are.

Probably why there have been multiple lawsuits won by the government over the past few years because they were screwing customers, canceling coverage or delaying coverage.

And don't even think about "denigrating" those wonderful oil companies.

By the way: While more people are losing their health insurance every day, and despite seeing a 10 percent drop in commercial enrollment to 1.4 million, UnitedHealthCare Profits Doubled Compared to Same Quarter Last Year.

Synova said..."And yet, Jeremy... even knowing the evil present in human beings... you want to give more power to other people over your own life."

Between you, Pogo, Alex, and elHombre I don't know who makes less sense.

Exactly WHO would I be giving this "power" to?

Right now we're all dependent upon for profit insurance companies who's primarily goal is to pay as little as possible for out health care needs, you appear to believe by upsetting that wonderful situation, we're going to get fucked.

I have news for you: We're already getting fucked and have been getting fucked for years on end.

Americans pay MORE for their insurance and treatment than any other country on the planet, and rank quite a bit down the ladder as far as treatment, longevity, infant mortality, and other aspects of health care.

Sane people weigh the various elements of any life choice they make. They weigh probable income against the investment of time and effort and money. They weigh other elements as well, if they'll enjoy the job, have time for their family, do something worth while that is important.

Very very few people do not try to maximize their income.

The rather formidable investment necessary to become a doctor, time-money-sweat... all that is undertaken with the expectation of compensation adequate to make up for those years and financial debt.

This is not cynicism. Not at all.

Because I do not believe, at all, that the measure of virtue is some fuzzy-bunny utopic altruism or that human beings, in order to be "good", have to have it or that freaking public policy can depend on it.

I do understand that support for public healthcare for all, so we can show how much we care and are not *mean* people, does depend on the belief in this altruistic ideal, because if people don't really behave according to this self-less sacrificial version of human nature... many *many* people will decide that it's not worth the years of medical school, the debt, or the stress in their personal relationships.

Jeremy wrote (2:23): [Terri Schiavo] was brain dead, ... yet people like yourself still think the poor woman should have remained alive so the nutcases on the Christian right could use her as some kind of standard bearer.

I don't believe I expressed an opinion about that. My point was that Schiavo did not die from an atrophied brain. She died as a result of an order issued by a government official, a judge, directing that she be denied any sustenance.

I would think that you, particularly as someone who is dangerously close to being brain dead, would be concerned about legislation that may expand the right of government officials to set priorities on matters of life and death.

Americans pay MORE for their insurance and treatment than any other country on the planet, and rank quite a bit down the ladder as far as treatment, longevity, infant mortality, and other aspects of health care.

Those figures have been repeatedly debunked, and I cannot believe that you don't know that.

For example, why does the U.S. rate lower on infant mortality? Because of the way that the statistics are kept, and what is considered a live birth. If you were to ignore premies and multiple births, as most of those countries do, we would look a lot better. And when comparing the U.S. to Canada, if you added all the difficult births sent down here from Canada to their statistics, instead of ours, things would shift a bit there too.

Right now we're all dependent upon for profit insurance companies who's primarily goal is to pay as little as possible for out health care needs, you appear to believe by upsetting that wonderful situation, we're going to get fucked.

I can understand why you may prefer the nameless bureaucrat over the evil capitalist, but can you understand why we don't? Why we think of the DMV, IRS, etc., and aren't excited about nameless bureaucrats making those decisions for us.

And, you forget one big distinction. When the insurance company denies coverage, and under the terms of your policy, it should have been covered, then you can sue the insurance company, and if they lose, they will often get hit with bad faith and outrageous conduct punitive damages. This has the effect of significantly reducing the wrongful denials.

But, if that nameless bureaucrat denies coverage, you are typically SOL. You can't sue the government, because it is protected from suits like that through the doctrine of Sovereign Immunity. You can, of course, write a letter to your Congressman, your Senator, President Obama, the head of the agency, or even the tooth fairy. But unless you are on a first name basis with one of them, you are still going to be SOL.

Do you really contend that the Obama/Dem bills will not result in limitations to health care for the elderly that will bring about earlier deaths?

Given around 60% of patients at a typical hospital are funded by Medicare or Medicaid (most of whom are elderly and whose numbers are poised to expand) that seems inevitable under any plan; either that or just ramp up the printing presses until the last boomer dies off.

Whether they do it to save the world, or just to make money, it doesn't really matter, when you are talking about destroying their livelihoods.

Most people who are seriously considering a career as a doctor are going to be scared away if they discover that they can't earn a living at it. It is just too much time and effort for no financial reward. We are talking school and training from age of 5 up through maybe the age of 30 or so. Add in a couple hundred thousand in educational debt, and the picture looks even worse. Add in the hours and the time on-call. No wonder physicians today are often counseling their kids to go into other lines of work.

And there is no reason to believe that ObamaCare, as it currently exists right now, would not make this significantly worse, through an attempt to impose Medicare type system of payments to the rest of us (without the rest of us being able to cross-subsidize those being covered by such a system).

Given around 60% of patients at a typical hospital are funded by Medicare or Medicaid (most of whom are elderly and whose numbers are poised to expand) that seems inevitable under any plan; either that or just ramp up the printing presses until the last boomer dies off.

But keep in mind that Medicare, Medicaid, etc. only work right now because they are massively cross-subsidized by all the rest of the paying patients.

Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.

Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.

The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires' case for a bureaucratically perfect, but inhumane, reason: She hadn't properly filled out a form. At death's door, de Vires should have done her paperwork better.

I think Jeremy is busy trying to think up shit he can fling at you, Alex. Given the seriousness of your challenge, he may have to resort to that greatest of insults; charging (without evidence) that you listen to Rush Limbaugh.

Do you really contend that the Obama/Dem bills will not result in limitations to health care for the elderly that will bring about earlier deaths?

Given around 60% of patients at a typical hospital are funded by Medicare or Medicaid (most of whom are elderly and whose numbers are poised to expand) that seems inevitable under any plan; either that or just ramp up the printing presses until the last boomer dies off.

I suspect both will be necessary to keep a public system afloat, current or future. Extended suffering and/or early death due to rationing, while printing money as fast as possible to keep the rationing at "tolerable" levels to prevent a patient rebellion.

chickenlittle wrote: "Given around 60% of patients at a typical hospital are funded by Medicare or Medicaid (most of whom are elderly and whose numbers are poised to expand)[limited health care leading to early death] seems inevitable under any plan...."

Maybe, but that is not currently proposed under existing Medicare, particularly for patients with "Medigap" insurance. It certainly seems inevitable under Obamacare.

My question to Jeremy, the euthanasia-loving putz, however, was whether he claimed it was not going to happen under Obamacare.

"Whether they do it to save the world, or just to make money, it doesn't really matter,..."

Because, in the end, there are all sorts of other ways to save the world that... cost less... give you more time with your family... are less constraining... and are less likely to result in people suing you for millions of dollars.

I am always thrilled to learn of those magnaminous altruistic doctors, the ones that did not go into medicine for money, who simply donate their services for breadcrumbs and a bite of cheese. Even room and board they shun, these secular saints, not to let filthy lucre stain their lily-white hands.

Bless them, these saints, these angels of mercy. But still, I want to see their 1040s please.

AJ Lynch said..."The Cash-for-clunkers programs is hitting all kinds of bureaucracy snags due to its complexity or inanity or both."

Yeah, it's REALLY hit a snag:

CNBC:The Obama administration announced this morning that it won't be suspending its "cash for clunkers" program.

According to some rough math, the clunkers program could bring July car sales to an annual rate of more than 12 million, which would be a 27 percent increase and the highest sales since September.

Kurt Karl, chief economist at Swiss Re in New York, said he thinks the program could even turn third-quarter GDP positive.

"That's big enough with production and sales to give a solid punch to the third quarter," Karl explained. "That would take my slightly negative [projection] and take it to the definitely positive area."